Emergency Nightmares - Rupture of Type III Thoracoabdominal Aneurysm

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aneurysm Repair

Background:

• Ruptured thoracoabdominal aneurysms (rTAA) pose significant surgical challenges.
• Endovascular repair is an attractive alternative to open surgery due to high mortality rates.
• Off-the-shelf endovascular devices, including branched endoprostheses, are crucial for emergency settings.

Observation:

• A 70-year-old patient presented with symptoms of a type III thoracoabdominal aneurysm.
• Computed tomography angiography revealed a large aneurysm with retroperitoneal hematoma.
• A branched endoprosthesis was selected for endovascular repair.

Findings:

• Intraoperative findings revealed an inverted implantation of the branched endoprosthesis.
• Successful cannulation of the superior mesenteric and left renal arteries was achieved.
• The patient experienced multiorgan dysfunction and died within 24 hours post-operatively.

Implications:

• Successful "off-the-shelf" branched endoprosthesis implantation demands strict adherence to anatomical criteria.
• Thorough pre-operative anatomical review is essential for correct device orientation and positioning.
• Careful intraoperative verification using multiple imaging planes is critical to prevent implantation errors.